Use a Health Directive(s) to Address Two Medical Questions

If you are over the age of 18, there are two questions you need to address regarding your medical care.

First, who do you want to make medical decisions for you if you become unable to do so yourself? This person is called your medical agent.

And second, what types of medical care do you want or not want if you become incapacitated or experience a medical crisis? There are several different types of health directives you can create to answer these two questions.

The most widely known and used health directives are:

  • the Virginia advance medical directive
  • the DNR (do not resuscitate) order
  • the POLST (Physician Orders for Life-Sustaining Treatment) form
  • the Five Wishes form

Four Health Directives Explained

While these four documents are quite different from one another, we find that they are easily confused. In this article, we will define each of these, as well as explain which we believe are the most useful and effective health directives for you to use.

1. Virginia Advance Medical Directive

The Virginia advance medical directive is a legal document regarding your medical care that does two things. It allows you to appoint your medical agent and empower them to act on your behalf when you are incapacitated. It also allows you to specify the types of medical treatment and care you do or do not want.

This health directive tells your doctor who your medical agent is and gives your agent guidance about what decisions to make. A Virginia advance medical directive is an absolute must. It should be drafted by an attorney who understands both the language that is familiar to the medical community and Virginia law (or the rules of your state if you do not live here in Virginia).

(Related: Advance Medical Directive Definition and FAQ)

It is important to keep in mind, however, that in an emergency no one is going to look at your advance medical directive.

For example, if you have a heart attack, first responders are not going to wait to act until someone finds and reads your advance medical directive. They will attempt to save your life as they are trained to do. If you do not want to be resuscitated in an emergency, you need another document to address this: a do not resuscitate order.

2. DNR Order

A do not resuscitate order (DNR) is a physician order that instructs health care providers not to do cardiopulmonary resuscitation (CPR) if a patient stops breathing or their heart stops beating. DNR orders are medically and ethically appropriate under certain circumstances. For many elderly people or those with advanced life-limiting illnesses, CPR can cause more damage than assistance.

The DNR order is a bright yellow document that draws immediate attention, and people should put it in an obvious place in their homes where first responders and family members are likely to see it if there is a medical emergency. An individual can state in their advance medical directive that they do not want CPR if their heart stops beating, but without a DNR order, this will not happen. If you do not want to be resuscitated under any circumstance, you will need a DNR order as well as your Virginia advance medical directive.

3. POLST Form

POLST stands for Physician Orders for Life-Sustaining Treatment. Like a DNR, it is a medical order for advanced elderly or frail individuals and is only enforceable if signed by a doctor. The POLST may include a DNR order, but it dives much deeper into choices regarding additional medical interventions.

A POLST form is not for everyone. It is for people who are gravely ill. It does not replace an advance directive, but it can complement one for people living with an advanced illness. Furthermore, your medical agent may help complete a POLST form when you become terminally ill.

4. Five Wishes Form

The Five Wishes form is a document you can create for yourself about the type of care that you want when you are dying, and it is sometimes used as a replacement for an advance medical directive. However, it comes with three issues that make it hard to use.

First, it is much too detailed for most people. It includes everything from your medical treatment and care wishes to the type of music you want playing in your hospital room and who you want at your funeral. Putting this level of minute detail into a document about medical care can complicate a situation rather than provide solutions.

Second, the Five Wishes form is not widely used, meaning some medical facilities are unfamiliar with how to interpret it. So, even when the Five Wishes form accurately reflects a patient’s desires, healthcare personnel may unknowingly misinterpret their wishes. This can cause difficulties with implementing the document and delay decision-making.

Third, the Five Wishes form does not include many of the basic provisions that are in most advance medical directives, such as HIPAA waivers and the grant of broad authority to the medical agent.

All in all, the Five Wishes has many benefits, such as helping you think through what you want and do not want at end of life. If you like it, we suggest using it as a practical tool to provide guidance to your loved ones and agents, but not to use it as a replacement for the Virginia advance medical directive.

So, What’s Next?

Here’s what you need to do:

First, if you are over the age of 18, work with an attorney to create a Virginia advance medical directive. While you don’t need to live in fear of the worst, you should live with an understanding that anything can happen at any time, even if you are young and healthy. Should you experience a medical crisis, you must have a health directive that explains your plan and appoints a medical agent to implement it.

Second, if you are living with an advanced illness, consider if either a DNR order or a POLST form is right for you. You can work with your medical doctor to create either of those health directives.


Are you ready to create your Virginia advance medical directive? Schedule an appointment with us. We’d love to meet you and help you prepare for anything the future may hold.


Joshua E. Hummer, Esq. is a licensed attorney who has been admitted in both Virginia and West Virginia. He is a graduate of the University of Virginia and has been practicing for over 15 years. While experienced in many parts of the law, Josh specializes in estate planning, estate administration, and elder law.